BATON ROUGE -- Gov. Bobby Jindal's proposed overhaul of the state's health care system for the poor cleared its second legislative hurdle Friday and is on its way to federal officials, where it will face scrutiny from the outgoing Bush administration and, most likely, the incoming Obama administration.

The approval by the Joint Legislative Committee on the Budget did not come without questions, however, as lawmakers demanded to Health and Hospitals Secretary Alan Levine that they be in the loop as details of any new system are devised.

Those conversations will continue in the coming months as the state awaits word on its proposals from the Centers for Medicare and Medicaid Services, which approves major changes to how states spend federal money on health care for the poor.

"We will send this off on Monday," Levine said after his second marathon hearing in two days. The Joint Health and Welfare Committee gave its blessing Thursday.

--- Transforming Medicaid ---

Jindal wants to expand coverage to reach more low-income households and, defined broadly, transform Medicaid from a system paying individual claims from medical providers into a system of privately run managed-care networks that offer integrated, comprehensive health plans.

Recipients would choose the networks, with the state paying a per-patient premium rate to the network.

The proposal is modeled after a relatively new system that Levine helped create in Florida, though the Louisiana proposal incorporates other wrinkles and pilot programs.

The Louisiana plan also hinges on federal officials essentially forgiving more than $770 million in Medicaid overpayments and other misuse of federal money in Louisiana programs over the years.

Rather than docking Louisiana's Medicaid payments over a series of years to recoup that money, the federal government would allow the state to commit to steering a corresponding amount into expanding its health care offerings.

Jindal has hailed the overhaul as a "market-driven" solution that will provide better health outcomes by coordinating a patient's care, emphasizing preventive care within a coordinated system of providers who are aware of a patient's treatment history and would avoid unnecessary procedures.

Opponents argue that the system would be a boon to the management networks, whose profit margin would consume money that now goes directly to medical providers.

Some lawmakers pointed specifically to North Carolina, where Medicaid patients are served by a fee-for-service model similar to the one in Louisiana, but with a greater level of coordination between primary-care doctors, specialists and other providers.

Most states have started moving away from fee-for-service models in recent years, and Louisiana is among about a dozen states that does not use managed care as a component of its Medicaid program.

--- 'The timing is a farce' ---

Rep. Karen Carter Peterson, D-New Orleans, cast the lone vote against the waiver proposal, in part, she said because of what she perceived as a rush to gain favorable approval from federal officials before Bush leaves office Jan. 20.

"I'm not comfortable going forward," said Peterson, who previously has bucked the first-year governor even on proposals that are sure to pass. "The timing is a farce," she said. "The impact (on health care access) is not clear. . . . The savings are not spelled out."

Sen. J.P. Morrell, D-New Orleans, echoed many of Peterson's concerns but said Levine has worked to educate lawmakers on the administration's ideas and pledged to work with lawmakers on their suggestions for the final blueprint.

"We've got to do something because we're 50th out of 50," he said, generalizing Louisiana's poor national rankings in many health surveys, from obesity and heart disease to cancer rates and infant mortality.

Levine dismissed any suggestion that Jindal is trying to push the issue before Bush, a fellow Republican, gives way to Democratic President-elect Barack Obama.

The secretary said there is virtually no possibility of the Bush administration having the time to approve the policy details of Louisiana's plan.

Further, he suggested that Bush provides no advantage over Obama: The plan combines concepts that won approval for other states, and it includes some components similar to Obama's plan, which leans heavily on subsidizing low- and middle-income households so they can obtain private insurance in the existing health care market.

Levine said the Legislature will have the final say because it must pass enabling legislation for new structures and regulations, while also controlling the state's annual budget.

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Bill Barrow can be reached at bbarrow@timespicayune.com or 225.342.5590.